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1.
Prax Kinderpsychol Kinderpsychiatr ; 70(1): 64-83, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33459220

RESUMO

Protection Against Violence and Abuse in Medical Institutions - Reasons, Prevalence and Implications for Practice Reported cases of (sexual) abuse in institutions as well as the results of surveys show that violence against children and adolescents, but also against adults, occurs also in medical institutions. There are still few studies on the frequency of these cases. However, the cases that have come to public attention show that medical institutions bear systemic risk factors for such assaults. On the other hand, medical institutions also play an important role in child protection, since many children and adolescents affected by maltreatment including sexual abuse come into contact with the medical system. It is necessary that medical institutions deal with this problem and develop respective institutional protection concepts. A protection concept is a system of measures that ensure better protection against assaults within an organisation. Important steps are analysis of risk factors, structural changes, the creation of plan of procedures and the development of an institutional attitude that assaults are not tolerated. Although the development of protection concepts takes time and resources, it has many advantages for institutions, such as an increased sense of security for professionals, because they know how to proceed in such situation. Now that the obligation to draw up protection concepts is anchored in the quality management guideline of the Federal Joint Committee (G-BA), all hospitals and practices must set out to develop appropriate concepts.


Assuntos
Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/estatística & dados numéricos , Instalações de Saúde , Violência/prevenção & controle , Violência/estatística & dados numéricos , Adolescente , Adulto , Criança , Abuso Sexual na Infância/prevenção & controle , Abuso Sexual na Infância/estatística & dados numéricos , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco
2.
PLoS One ; 15(10): e0239897, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045018

RESUMO

Violence-free family ties, non-violent peers or attachment to society have been pointed out as protective factors against different types of extremism and violent radicalization by international literature. However, more detail needs to be provided about which specific aspects within these realms (friendship/family/community) are effective in challenging violence and how they operate in practice. Recent research conducted under the framework of the PROTON project (Horizon 2020) has analyzed the social and ethical impacts of counter-terrorism and organized crime policies in six European countries. In this article we discuss some identified common features among practices that, developed by organized actors operating at the local level (e.g.: grassroots-based associations, educational institutions, other type of organized networks for prevention, NGOs), are contributing to preventing youth violent radicalization, a phenomenon of growing concern in Europe and beyond. Standing on a solid rejection to violence, these shared features are the following: a bottom-up approach in setting allies with key stakeholders from the community or/and family members to intervene; the promotion of trustworthy and healthy friendship relationships; debunking the lure surrounding violent subjects ("false heroes") and violence in the different contexts, especially in the socioeducational one.


Assuntos
Controles Informais da Sociedade/métodos , Meio Social , Participação dos Interessados , Violência/prevenção & controle , Adolescente , Europa (Continente) , Feminino , Humanos , Masculino , Violência/psicologia , Adulto Jovem
7.
BMC Public Health ; 20(1): 1051, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32616007

RESUMO

BACKGROUND: Violence against children is a pervasive public health issue, with limited data available across multiple contexts. This study explores the rarely studied prevalence and dynamics around disclosure, reporting and help-seeking behaviours of children who ever experienced physical and/or sexual violence. METHODS: Using nationally-representative Violence Against Children Surveys in six countries: Cambodia, Haiti, Kenya, Malawi, Nigeria and Tanzania, we present descriptive statistics for prevalence of four outcomes among children aged 13-17 years: informal disclosure, knowledge of where to seek formal help, formal disclosure/help seeking and receipt of formal help. We ran country-specific multivariate logistic regressions predicting outcomes on factors at the individual, household and community levels. RESULTS: The prevalence of help-seeking behaviours ranged from 23 to 54% for informal disclosure, 16 to 28% for knowledge of where to seek formal help, under 1 to 25% for formal disclosure or help seeking, and 1 to 11% for receipt of formal help. Factors consistently correlated with promoting help-seeking behaviours included household number of adult females and absence of biological father, while those correlated with reduced help-seeking behaviours included being male and living in a female-headed household. Primary reasons for not seeking help varied by country, including self-blame, apathy and not needing or wanting services. CONCLUSIONS: Across countries examined, help-seeking and receipt of formal services is low for children experiencing physical and/or sexual violence, with few consistent factors identified which facilitated help-seeking. Further understanding of help seeking, alongside improved data quality and availability will aid prevention responses, including the ability to assist child survivors in a timely manner.


Assuntos
Saúde da Criança/estatística & dados numéricos , Revelação/estatística & dados numéricos , Sobreviventes/psicologia , Violência/psicologia , Adolescente , Camboja/epidemiologia , Criança , Feminino , Haiti/epidemiologia , Humanos , Quênia/epidemiologia , Modelos Logísticos , Malaui , Masculino , Prevalência , Delitos Sexuais/psicologia , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos , Tanzânia/epidemiologia , Violência/prevenção & controle
11.
Crim Behav Ment Health ; 30(2-3): 141-150, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32483870

RESUMO

Dialectical behaviour therapy (DBT) is a therapy model incorporating elements of Eastern philosophies and cognitive behavioural principles. Originally designed for people struggling with chronic suicidality and borderline personality disorder (BPD), it has been adapted to treat complex, multi-diagnostic presentations, such as those in forensic mental health settings. To date, there has been little evaluation when the primary diagnosis is of psychosis. To explore the effectiveness of DBT, with patients, with multiple comorbidities, including psychosis, in a forensic psychiatric inpatient setting. A descriptive outcome study with a cohort of offender-patients in one specialist forensic mental health unit. Before and after treatment change scores were compared on anger, aggression, hopefulness, coping abilities, emotional intelligence, insight and subjective symptom severity scales, as well as staff-rated risk, and length of stay. Nine men and five women residents in one Canadian secure hospital completed a standard DBT programme, and self-ratings, over about 1 year. Scale scores indicated significantly increased insight and acknowledgment of problems. Apparently increased anger and vengeance scores were clinically associated. Independent staff ratings indicated reductions in risk and most patients achieved early release. This study provides support for extension of the use of DBT to offender-patients with psychosis among the complex mix in their presentation. It suggests that a randomised controlled trial with cost-benefit analysis is warranted, as well as further work, to promote understanding of mechanisms of effectiveness.


Assuntos
Transtorno da Personalidade Borderline/terapia , Criminosos/psicologia , Terapia do Comportamento Dialético/métodos , Psiquiatria Legal/métodos , Prisioneiros/psicologia , Violência/prevenção & controle , Adaptação Psicológica , Adulto , Agressão , Ira , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Canadá , Inteligência Emocional , Emoções , Feminino , Esperança , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Transtornos Psicóticos , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
12.
PLoS One ; 15(6): e0234608, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579607

RESUMO

STATEMENT OF PURPOSE: Intentional violent injury is a leading cause of disability and death among young adults in the United States. Hospital-based violence intervention programs (HVIPs), which strive to prevent re-injury through intensive case management, have emerged as a successful and cost-effective strategy to address this issue. Despite the importance of strong therapeutic relationships between clients and their case managers, specific case manager behaviors and attributes that drive the formation of these relationships have not been elucidated. METHODS: A qualitative analysis with a modified grounded theory approach was conducted to gain insight into what clients perceive to be crucial to the formation of a strong client-case manager relationship. Twenty-four semi-structured interviews were conducted with prior clients of our hospital's HVIP. The interviews were analyzed using constant comparison method for recurrent themes. RESULTS: Several key themes emerged from the interviews. Clients emphasized that their case managers must: 1) understand and relate to their sociocultural contexts, 2) navigate the initial in-hospital meeting to successfully create connection, 3) exhibit true compassion and care, 4) serve as role models, 5) act as portals of opportunity, and 6) engender mutual respect and pride. CONCLUSIONS: This study identifies key behaviors of case managers that facilitate the formation of strong therapeutic relationships at the different stages of client recovery. This study's findings emphasize the importance of case managers being culturally aligned with and embedded in their clients' communities. This work can provide a roadmap for case managers to form optimally effective relationships with clients.


Assuntos
Gerentes de Casos/normas , Hospitais , Violência/prevenção & controle , Adulto , Terapia Comportamental , Gerentes de Casos/psicologia , Feminino , Teoria Fundamentada , Humanos , Masculino , Relações Profissional-Paciente , Adulto Jovem
13.
J Spec Oper Med ; 20(2): 104-109, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573745

RESUMO

In summer of 2017 in Charlottesville, Virginia, white nationalists clashed with counterprotestors, ultimately leading to the death of three people and leaving 34 more injured. Soon after, the same group was granted permission to speak on the campus of the University of Florida in Gainesville, Florida. Despite our college town having limited resources and personnel, the comprehensive and extensive preparation preceding the event ensured a peaceful resolution for such a large and potentially volatile situation. The preparatory steps required joint efforts from local and state partners in law enforcement, emergency medical services, and emergency departments. We describe here the situation we faced, the pre-event preparations, the response in the field and in our emergency department, and the outcomes from an emergency and tactical medicine perspective. We hope our successful experience will impart knowledge for similar events.


Assuntos
Fala , Universidades , Violência/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Florida , Humanos , Aplicação da Lei
14.
BMC Womens Health ; 20(1): 98, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380986

RESUMO

BACKGROUND: Nearly half of the women experience violence across their lifespan in all the provinces of Pakistan at an alarming rate. Despite knowing the prevalence, there has been meager progress in developing strategies to combat violence at individual, family, or community level. Many interventions suggested in other countries have been pilot tested but the effects of those interventions had been limited. Therefore, the aim of this study is to understand the voices of stakeholders to reduce Violence Against Women (VAW) and to explore the possible community-based strategies that could be implemented in Pakistan. METHODS: A total of 14 Key Informant Interviews (KIIs) and 18 Focus Group Discussions (FGDs) were held across all four provinces of Pakistan. Participants were purposefully recruited and all the interviews were audio-recorded. Transcriptions were open coded and content analysis was done to emerge codes, categories and themes. Ethical approval was obtained from Aga Khan University Ethics Review Committee. RESULTS: Three major themes emerged on community members and stakeholders' views on VAW: a) community's perception of VAW b) the repercussions of VAW, and c) multiple voices regarding strategies to reduce VAW. Participants voiced the need of standing against the status quo, role of awareness and education: regarding capacity building skills, promotion of women rights and women empowerment through Life Skills Based Education (LSBE) through national health works program, has been proposed as an innovative strategy to reduce VAW. CONCLUSIONS: The responsibility to bring about a substantial change in behavior and attitudes must begin with engaging men in all the interventions that aim to reduce violence. Since, VAW is very much linked with the cultural norms, so, without community stakeholder's involvement and participation it could never be reduced. Keeping the existing socio-cultural dynamics in mind, the need of time is to design and implement innovative interventions that are culturally and contextually appropriate and can be expanded across the country.


Assuntos
Violência Doméstica , Maus-Tratos Conjugais/prevenção & controle , Violência/etnologia , Violência/prevenção & controle , Atitude , Criança , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Paquistão , Pesquisa Qualitativa , Maus-Tratos Conjugais/psicologia , Violência/psicologia , Direitos da Mulher
15.
BMC Public Health ; 20(1): 621, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375840

RESUMO

BACKGROUND: Sugira Muryango is a father-engaged early child development and violence-prevention home-visiting programme delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty (Ubudehe 1, the poorest category in the Government of Rwanda's wealth ranking) who receive Sugira Muryango in combination with a government-provided social protection programme demonstrate greater responsive, positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC). METHODS: Using detailed maps, we grouped closely spaced villages into 284 geographic clusters stratified by the type of social protection programmes operating in the village clusters; 198 clusters met all enrolment criteria. Sugira Muryango was delivered to n = 541 families in 100 treatment clusters with children aged 6-36 months living in extreme poverty. We assessed changes in outcomes in intervention and n = 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate clustering. RESULTS: Families receiving Sugira Muryango improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen's d = 0.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen's d = 0.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR = 0.30: 95% CI: 0.19, 0.47) and in violent victimisation of female caregivers by their partners (OR = 0.49, 95% CI: 0.24, 1.00) compared with UC. Moreover, children in families receiving SM had a 0.45 higher increase in food groups consumed in the past 24 h (Cohen's d = 0.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR = 4.43, 95% CI: 1.95, 10.10) and fever (OR = 3.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR = 3.39, 95% CI: 2.16, 5.30) compared with UC. Finally, Sugira Muryango was associated with decreased caregiver depression and anxiety (OR = 0.58, 95% CI: 0.38, 0.88). CONCLUSIONS: Sugira Muryango led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02510313.


Assuntos
Pai/psicologia , Visita Domiciliar , Relações Pais-Filho , Pobreza/psicologia , Política Pública , Violência/prevenção & controle , Adulto , Agressão/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Cuidadores/psicologia , Desenvolvimento Infantil , Pré-Escolar , Análise por Conglomerados , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Lactente , Masculino , Avaliação de Programas e Projetos de Saúde , Ruanda/epidemiologia , Inquéritos e Questionários , Violência/psicologia
16.
Health Qual Life Outcomes ; 18(1): 151, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32450852

RESUMO

BACKGROUND: Increased violent events happen in the general hospitals in China and yet non-psychiatric departments do not have tools for violence-tendency screening. METHODS: The current study developed and evaluated two Inpatient Psychological Experience Questionnaires (IPEQs) for the screening of violence-related six mental health disorders: (Inpatient Psychological Experience Questionnaire-1 (IPEQ-1): anxiety, depression and suicidality; Inpatient Psychological Experience Questionnaire-2 (IPEQ-2): paranoid personality disorder, emotionally unstable personality disorder and histrionic personality disorder). Two initial IPEQs (IPEQ-1: 37 items and IPEQ-2: 30 items) were developed and assessed by domain experts. Then 1210 inpatients were recruited and divided into three groups (160, 450 and 600 samples, respectively) for IPEQs item selection and evaluation. During the two-stage item selection, three statistical methods including Pearson's correlation coefficient, exploratory factor analysis and item response theory were applied. For the item evaluation, Cronbach's alpha coefficient, test-retest reliability, criterion-related validity and construct validity of the final questionnaires were measured. RESULTS: Twelve items were selected for each IPEQs. Cronbach's alpha coefficients were 0.91 and 0.78 for IPEQ-1 and IPEQ-2, respectively. Test-retest replication ratios were 0.95 and 0.87 for IPEQ-1 and IPEQ-2, respectively. Correlation coefficients between different disorders and their related-tools scores were [0.51, 0.44] and [0.40, 0.44] for IPEQ-1 and IPEQ-2, respectively and were significant (P < 0.01). Confirmatory factor analysis supported the validity of the final IPEQs (P < 0.05), and the model fit index met the criterion generally. CONCLUSION: The IPEQs developed in this study could be effective and easy-to-use tools for screening inpatients with violence-intendancy in non-psychosomatic departments.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos da Personalidade/diagnóstico , Inquéritos e Questionários/normas , Violência/prevenção & controle , Adulto , China , Análise Fatorial , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Reprodutibilidade dos Testes
17.
Emerg Med Clin North Am ; 38(2): 437-451, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336335

RESUMO

Violent, combative and intoxicated patients are a common problem in the emergency department, and the emergency physician must be prepared to control the situation safely and effectively when a patient begins to exhibit dangerous behavior. This article reviews initial de-escalation techniques to reduce the need for patient restraint. It then details the 2 types of restraints (physical and chemical) and the clear indications for each type. The high-risk nature of utilization of restraints is reviewed, as well as the means by which to ensure patient and staff safety and decrease adverse outcomes.


Assuntos
Sedação Consciente , Serviço Hospitalar de Emergência , Restrição Física , Humanos , Transtornos Mentais/terapia , Gestão de Riscos , Violência/prevenção & controle
18.
PLoS One ; 15(4): e0230793, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240231

RESUMO

INTRODUCTION: Violence against health care workers is a major issue in health care organisations and is estimated to affect 95% of workers, presenting an enormous risk for workers and employers. Current interventions generally aim at managing rather than preventing or minimising violent incidents. To create better-targeted interventions, it has been suggested to shift attention to the perpetrators of violence. The aim of this study was to identify and discuss the perceptions, held by Emergency Department nurses, about perpetrators of occupational violence and aggression. METHODS: Two focus groups were conducted with Emergency Department nurses at a major metropolitan hospital in Australia. In the focus groups, the nurses' perceptions about perpetrators of violence against health care workers were identified and discussed. The results were analysed using descriptive analysis. RESULTS: This study confirmed that violence is a major issue for Emergency Department nurses and has a considerable impact on them. Participants acknowledged that violence at work had become an intrinsic part of their job and they tend to focus on coping mechanisms. The nurses identified six overlapping groups of perpetrators and described their approach to dealing with these perpetrators. The results highlighted additional factors that impact on the occurrence and management of violence, such as the presence of security, wait times, and the triage system. CONCLUSIONS: Based on the focus groups with Emergency Department nurses we conclude that violence at work is an everyday danger for Emergency Department nurses, who feel vulnerable and recognise that it is not within their power to solve this issue given the societal component. Our conclusion is that attention needs to shift from equipping workers with tools to manage violence to the perpetrator and the development of interventions to reduce violence from targeted perpetrator groups.


Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem no Hospital/psicologia , Violência no Trabalho/prevenção & controle , Adulto , Agressão/psicologia , Austrália , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Violência/prevenção & controle , Local de Trabalho , Violência no Trabalho/tendências
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